To mark the recent publication of the new edition of Dying and Death in Canada, Herbert C. Northcott provides some background in how the book has evolved over multiple editions, and how this new edition incorporates extremely important and timely issues such as post-traumatic stress experienced by end-of-life caregivers and first responders, as well as physician-assisted death and the debate surrounding it that is currently playing out in Canada.
Some years ago, I had the opportunity to teach an undergraduate course at the University of Alberta on the sociology of dying and death. Previous instructors had used textbooks written in the United States. There were a number of such textbooks. They were comprehensive and expensive (especially in Canadian dollars). They examined dying and death in the American socio-cultural context. I selected an American text that I thought my students would find accessible, readable, and enjoyable. However, Canada and the United States differ demographically and their health care systems are very different. These differences impact substantially on patterns and experiences of dying and death in the two countries. I felt that a book examining dying and death in Canada was necessary.
I invited Dr. Donna Wilson from the Faculty of Nursing at the University of Alberta to collaborate with me. We wrote a proposal for a monograph on dying and death in Canada. This monograph was conceptualized initially as a supplement to whichever American textbook might be adopted for courses on dying and death in Canada. Garamond Press agreed to publish our monograph and it came into existence in 2001. I adopted it for classroom use along with the usual American textbook. Dr. Wilson and I subsequently updated our book and a second edition was published in 2008. By then, Garamond Press had become a part of Broadview Press and subsequently our monograph came to the Higher Education Division at the University of Toronto Press.
The time came when the second edition was no longer adequate. It was out-of-date. Furthermore, student evaluations of the course I was teaching were indicating increasing resistance to the American text I had been using. Dr. Wilson and I decided Dying and Death in Canada should no longer simply act as a Canadian supplement to an American text, but should be developed fully as a stand-alone textbook. This meant updating existing information, adding new topics, extending the length, and adding more pedagogical material including images and discussion questions.
We proposed that we add a chapter featuring professional voices. The previous editions had concentrated on dying and on the loved ones who cared for the dying and grieved when death occurred. But we did not explore in detail the experiences and perceptions of those various professionals who become involved with the dying and their loved ones. End-of-life has become a partnership involving the dying person, the family of the dying, and various health care workers. For this partnership to work, each side has to understand the other side. It is important to examine what the dying and their family caregivers expect and experience with respect to end-of-life care. It is also important to examine how health care workers and institutions implement end-of-life care and negotiate a partnership with the dying and their families. Both sides want the dying person to have as good a death as possible. However, family caregivers and health care professionals sometimes have difficulty communicating and agreeing on end-of-life care. This book helps each side understand the other. As such, it is useful for the dying and their family caregivers and also useful for those who work with the dying every day in their professional lives.
The proposed new chapter soon became two. These new chapters feature professional voices and examine the experiences of first responders (including police officers, firefighters, and emergency medical technicians/paramedics); health care workers (including physicians, nurses, and aides); and death care workers (including medical examiners and funeral directors). We note that dying and death can be problematic for professional caregivers. The final chapter critically examines the phenomenon of post-traumatic stress and the need to care for the caregivers. Post-traumatic stress used to be stigmatized, ignored, hidden, or whispered about. It was unprofessional. And so health care personnel exposed to traumatic or frequent deaths, ranging from paramedics to oncologists, found it difficult to reveal their emotional reactions that can range from depression and burnout to suicide. Today, the media frequently report stories about post-traumatic stress disorder (PTSD). We felt it was important to discuss the phenomenon of PTSD and its movement out of the shadows and into public awareness.
Another evolving story that is currently in the news is the shift in public opinion and practice regarding assisted (or hastened) death. We felt it was important to examine the history of assisted death and its current debate in Canada. A few countries have led the assisted death movement. The Netherlands and Belgium for example were the first countries to legalize physician-assisted suicide and, subsequently, euthanasia. Several states in the USA, beginning with Oregon, have legalized physician-assisted suicide. The Province of Quebec, and Canada as a whole, have recently indicated their intentions to implement physician-assisted death, although details are still being worked out. We felt it critical that we explore the assisted death movement as it is playing out in Canada.
Dr. Wilson and I are from different academic disciplines. I am a sociologist who has focused my teaching and research on issues in aging, health and illness, and dying and death. Dr. Wilson is a professor of nursing and has worked many years with living and dying patients in hospitals and elsewhere. This has resulted in a rich collaboration as we explore our different points of view and share our varied insights and experiences.
Herbert C. Northcott is Professor of Sociology at the University of Alberta. Donna M. Wilson is Professor of Nursing at the University of Alberta.
Note: If you are an instructor and would like to consider Dying and Death in Canada as a required text for an upcoming course, please contact requests@utphighereducation.com to request an examination copy of the book.
